The first step in working with companies for on-the-job injuries, is to let them know that you are out there. You may use either a direct or indirect approach. For example, one individual may contact a company to bring them some lifting posters; another may spend $1,200 a week advertising for injured workers. Two different approaches, but trust between the company and yourself should be the obvious goal. Therefore, establishing a niche for yourself in working with industry is a necessary step in your anticipated relationship with any company. Your history in dealing with employees from companies is established or is being established by the way you presently conduct your management of workers' compensation cases.
In treating injured employees there are several basic things to do that will begin to build trust between yourself and the particular company.
First, communicate with the person handling the case from the company's side. Initially you may be the recipient of a hostile reaction, which is understandable. I recently spoke with an occupational nurse that told me she received a time off slip for one of the plant's employees. The neurologist who wrote the disability for a month's duration would not speak to the nurse when asked if there was any way that the company could provide safe, light duty for that person. Industry has been battered time and time again from uncooperative doctors who are totally and without question sympathetic to the patient. This is obviously the easy way to make a living because patients refer other patients for this protection and concern. This approach will be the downfall for the treating practitioner, as companies cannot and will not continue to accept this abuse.
The sad part of the story is time and time again the working stiff gets the shaft. A fellow with three kids and payments on the trailer needs to work to provide for the family the best he can. If he gets hurt and has to deal with three different doctors, an attorney, and the inevitable hassles from the company as things get worse, he usually just does what people tell him is right which may not be in his best interest. Everyone gets paid, Joe has a black mark on his record, and work is now a place to go that is never the same.
Rule number one: Communicate and relay that you will do your best to cooperate with the company.
Second, provide immediate documentation as to the extent of the problem. Provide an initial report to the company that contains a history of the occurence that shows causation or lack of it. If the problem is cumulative trauma over the last several months try to document an event or the specific job that aggravates the condition the most.
Third, provide examination findings that use acceptable testing procedures so that when this document is forwarded to review for payment, there is reasonable language that will be understood. The same thing needs to be done for the next section concerning radiological findings. The best documentation would be Dr. Sweere's work on the approximately 34 radiologic findings he has lectured on.
The fourth component would be your impressions. This is not written in blood. Many times I will say, for example, "At this point my impression is an acute sprain of the lumbar spine; however, disc involvement may have to be ruled out if symptomatology does not resolve as expected." This doesn't have to be a big deal, just tell it like you think it is.
Fifth, state your course of treatment, specifically how long before re-exam and what specifically you are going to do.
Sixth, discuss the disability. If you think that the individual could perform any light duty, call and ask what is available to get that person back to work. This is an excellent way to begin to build a relationship with the company contact.
This report will initiate a relationship of trust and teamwork between you and the company. Some companies will continue to be hostile; you must do what is right and not worry about it. You can bet your last dollar that with their bad attitude the cost of claims is absolutely killing them, and they are not yet interested in solving their problem. Remember, you can't help someone who doesn't want to be helped; don't take it personally.
I believe that chiropractic has such an obvious place in industry that it will continue to help individuals regardless of protocol. By following a few simple guidelines we can facilitate introduction into those companies that have been under siege from the typical propaganda that channels those injuries into a system that does not have a good history of success in treating musculoskeletal conditions.
Theodore Oslay, D.C.
DeKalb, Illinois
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